CT、MRI在诊断脑后部可逆性脑病综合征中的价值

目的:试验并研究CT、MRI在诊断脑后部可逆性脑病综合征中的临床诊断价值。方法:从于2015年1月至2018年9月来我院进行脑后部可逆性脑病综合征(PRES)诊断治疗的156例患者,对其临床诊断资料进行回顾性分析与比较,并进行CT、MRI临床诊断。结果:CT平扫影像上显示在患者的脑白质区都存在左右对称、边界模糊的低密度、斑片状的影像,并且分布在患者的双侧顶枕叶;MRI扫描影像上则显示在患者的皮质下区或者白质区存在病灶信号,主要是呈现斑片状的异常信号。其中,T1WI上的病灶呈现出的是等信号或者稍低信号,T2WI与T1 FLAIR上的病灶则呈现为高信号,DWI主要呈现为等信号,病灶的边缘模糊,并且存在轻微占位效应。结论:运用CT、MRI扫描在诊断脑后部可逆性脑病综合征中能够提供有效的诊断参考依据,具有广泛的临床诊断价值,值得推广应用。     

血液循环速度与冠脉CT血管造影增强效果的相关性及对比剂优化方案

  目的  探究血液循环速度与冠状动脉CT血管造影（CTA）增强效果的相关性,并分析对比剂优化方案。  方法  选取2020年1月~2021年4月于我院行冠状动脉CT血管造影患者161例,按照血液循环速度分为快速组（n=32）、中等组（n=35）和缓慢组（n= 94）,分析血液循环速度与增强效果关系,并将缓慢组分为A、B、C 3个亚组,A组与快速组、中等组使用的对比剂浓度和注射速率相同（均为碘浓度320 mgI/mL,速率5 mL/s）;B组采用对比剂的碘浓度为350 mgI/mL,速率5.5 mL/s;C组采用对比剂的碘浓度为370 mgI/mL,速率5.5 mL/s,比较各组伪影发生、室间隔显示、冠脉CT值及图像质量情况。  结果  快速组、中等组、B组、C组产生伪影概率均低于A组,且快速组低于中等组,C组低于B组（P < 0.05）;快速组、中等组、B组、C组主动脉根部CT值、图像质量评分、室间隔显示评分均高于A组,且快速组高于中等组,C组高于B组（P < 0.05）。  结论  血液循环速度能增加冠脉CTA增强效果,清晰显示室间隔,对于血液循环较慢者可适当增加对比剂浓度和注射速率以保证图像质量。      

腹腔镜下经胆囊管治疗继发胆总管结石的疗效分析

目的分析腹腔镜下经胆囊管治疗继发胆总管结石的临床疗效。方法选取在该院接受治疗的胆结石继发胆总管结石的患者120例,按照随机的方法平均分给观察组与对照组,每组60例患者。观察组实施腹腔镜下经胆囊管治疗继发胆总管结石的方法治疗,对照组采用传统的腹腔镜下胆总管探查T管引流术。治疗一段时间后,比较两组患者的手术时间、胃肠功能恢复时间、术中出血情况、并发症的总发生率和住院时间。结果观察组的术中手术时间、胃肠功能恢复时间、术中出血情况、并发症的发生率和住院时间均少于对照组;其中观察组在住院时间(5.4±2.1)d明显低于观察组(16.5±6.9)d,术后水、电解质紊乱、伤口疼痛和感染等并发症总发生率(6.66%)明显低于对照组的总发生率(61.67%),差异具有统计学意义(P0.05)。结论腹腔镜下经胆囊管治疗胆结石合并胆总管结石优于传统的腹腔镜下胆总管探查T管引流术,术中的出血量少、更安全且并发症少,恢复快,建议广泛使用。     

慢性肾功能衰竭患者血小板膜糖蛋白Ⅰb/Ⅸ/Ⅴ复合物表达的研究

目的:观察慢性肾功能衰竭(CRF)患者血小板膜糖蛋白(GP)Ⅰb/Ⅸ/Ⅴ复合物及其组分GPⅠbα的表达与正常人之间的差异。方法:采用流式细胞术检测CRF患者血小板GPⅠb/Ⅸ/Ⅴ复合物和GPⅠbα的表达,采用比浊法检测其血小板最大聚集率(MA)。结果:CRF患者GPⅠb/Ⅸ/Ⅴ复合物、GPⅠbα表达和MA明显低于正常对照组(P=0.013,P=0.001,P=0.006);相关性分析显示GPⅠb/Ⅸ/Ⅴ复合物和GPⅠbα的表达与血肌酐呈明显负相关(P=0.041,P=0.026)。结论:血小板GPⅠb/Ⅸ/Ⅴ复合物作为凝血酶和血管性血友病因子的受体,在CRF患者体内的表达下降,导致血小板聚集功能障碍,可能是CRF出血倾向的重要原因之一。     

电针对全膝关节置换术后辅助镇痛的临床疗效观察

ObjectiveTo observe the clinical effect of electroacupuncture (EA) for alleviating pain after total knee arthroplasty (TKA) in the patients with the end-stage knee osteoarthritis and its mechanism.MethodsA total of 80 subjects with unilateral TKA were divided into a celecox group (40 cases) and an EA combination group, using random number table in clinical trial. In the celecox group, after operation, celecox tablets were taken orally for analgesia. In the EA combination group, on the base of oral administration of celecox tablets, on the day of operation, EA was exerted on the affected limb, with disperse-dense wave, 2 Hz/100 Hz in frequency, 3 mA in current intensity, once daily, 30 min each time, consecutively for 3 days. On the day after operation, Wàiqiū (外丘GB36), Jīnmén (金门BL63), Nèimádi?n (内麻点EX-LE29) and Zúsānl? (足三里ST36) were selected in EA. 24 h after removing the drainage tube, Liángqiū (梁丘ST34), Xuèh?i (血海SP10), Dìjī (地机SP8) and Yánglíngquán (阳陵泉GB34) were used. Separately, the operation time, blood loss, the pain VAS score before operation, the pain VAS scores after 24, 48 and 72 h of treatment and Self-rating scale of sleep (SRSS) score, as well as the stress factors, i.e. IL-6, IL-10 and TNF-α in serum were recorded and determined in the subjects of two groups.ResultsBefore treatment, the operation time and blood loss were not different between two groups (both P > 0.05). 24, 48 and 72 h after operation, the visual analogue scale (VAS) scores in the celecox group were all higher than those in the EA combination group (all P < 0.05). After treatment, SRSS score in the EA combination group was lower than that in the celecox group (P < 0.05). The expressions of IL-6 and TNF-α were reduced gradually in the two groups (all P < 0.05) and the values in the EA combination group were lower than the celecox group (P < 0.05). IL-10 was increased gradually (P < 0.05) and the value in the EA combination group was higher than the celecox group (P < 0.05).ConclusionElectroacupuncture effectively alleviates pain induced by TKA and the curative effect is definite. This therapy contributes to accelerating rehabilitation and its effect mechanism may be related to promoting the release of anti-inflammatory factor, IL-10 and inhibiting the expressions of inflammatory factors, IL-6 and TNF-α.     

严重肝外伤62例治疗体会

目的 探讨严重肝外伤的各种手术止血方法，以期找出最有效最合理的止血手段。方法 回顾分析我院62例严重肝外伤的治疗经验，其中Ⅲ级38例，Ⅳ级21例，Ⅴ级3例。结果 治愈55例，治愈率88．71％，死亡7例，死亡率11．29％。术后并发症19例，占30．64％。结论 局部清创加带血运大网膜填塞及缝合修补术是治疗严重肝外伤的首选方法，无菌绷带填塞法是治疗严重肝外伤的重要手段。     

桂枝芍药知母汤治疗痛风性关节炎有效性与安全性的Meta分析

目的 评价桂枝芍药知母汤治疗痛风性关节炎（GA）的有效性与安全性。方法 通过检索中国学术期刊全文数据库（CNKI）、万方数据库（Wanfang Data）、中国生物医学文献数据库（CBM）、维普中文期刊全文数据库（VIP）、PubMed、Embase、WebofScience和Cochrane Library等中英文数据库,检索时间为建库至2022年6月桂枝芍药知母汤治疗GA的随机对照试验（RCT）。由2位研究员独立对文献进行筛选、提取数据和质量评价后,运用RevMan 5.3和Stata 14软件进行Meta分析。结果 共纳入12项RCTs,包括1142例患者,其中对照组（常规治疗）570例、试验组（常规治疗联合桂枝芍药知母汤）572例。Meta分析结果显示,与对照组比较,试验组临床有效率更高[RR=1.19,95% CI （1.14,1.25）,P<0.00001],血尿酸显著降低[MD=-89.36,95% CI （-153.66,-25.05）,P=0.006],明显改善红细胞沉降率[MD=-4.84,95% CI （-6.68,-2.99）,P<0.000 01],明显降低C-反应蛋白水平[MD=-2.14,95% CI （-3.19,-1.09）,P<0.000 01],明显改善白细胞介素-6水平[MD=4.39,95% CI （1.27,7.52）,P=0.006],明显降低不良反应[RR=0.26,95% CI （0.16,0.41）,P<0.000 01]。敏感性分析提示研究结果具有较好的可靠性和稳定性。结论 桂枝芍药知母汤治疗GA临床疗效显著且安全性好。但文献数量少、质量偏低,仍需更多高质量、多中心、大样本的RCTs加强证据强度。     

Binding of EGF1 Domain Peptide in Coagulation Factor Ⅶ with Tissue Factor and Its Implications for the Triggering of Coagulation

The binding function of EGF1 domain peptide with tissue factor(TF)and its ability of triggering coagulation were explored.The TF expression model in vitro was established by lipopolysaccha-ride induction.The affinity of EGFP-EGF1 and TF expressing cells was analyzed by fluorescence microscopy and flow cytometry(FCM).The affinity of EGFP-EGF1 and rat soluble TF was quantitated by surface plasmon resonance(SPR).The ability of EGFP-EGF1 in triggering coagulation was tested by prothrombin time assay.The FCM res...